What Can I Do to Help?

October 24, 2017

The staff of the UTHealth Harris County Psychiatric Center came together to care for their patients.

By Daniel Oppenheimer

Hurricane Harvey was the 10th hurricane that Stephen Glazier has lived and worked through as a health care executive. Glazier, COO of UTHealth Harris County Psychiatric Center (HCPC), has been through hurricanes in Florida, Georgia, and Texas and says each experience has helped him prepare for the next, but there are always unanticipated challenges.

“When we started getting warnings about Harvey, I packed three days’ worth of clothes,” he says. “I was there for six days. I’ve never had to stay on site for that long.”

In the end, Glazier and more than 50 other staff members at HCPC -- the largest provider of inpatient psychiatric care in Houston -- stayed at the hospital from Friday evening on Aug. 24 through Wednesday, Aug. 30. Working in two shifts, the doctors, nurses, technicians, executives, administrators and custodians cared, fed, housed and did laundry for more than 200 patients, keeping them safe and healthy during the crisis.

The hospital itself never flooded, but about ten percent of the staff, including the hospital’s medical director and executive director, had homes that were damaged by the rains and flooding.

“It was a really scary time, and a lot of people felt really torn,” says Glazier, whose family had to evacuate from three successive homes while he was on duty at the hospital. “There was a deep commitment to helping the patients here, but also a need to find a way to take care of our families. We had two employees who had a friend or family member who died in the floods.”

Stephen Glazier (far right) and his colleagues at HCPC during the flooding.

Texas Health Journal spoke to Glazier on the phone about his experience of the hurricane, how the hospital prepared for it, and what lessons he learned about his fellow staff, the city, and the ways in which people can come together in times of crisis.

Texas Health Journal: Start at the beginning. When did you arrive at the hospital for good?

Stephen Glazier: We called everyone in on Friday evening. In one sense that was too early, because it wasn’t that bad most of the day on Saturday. But Houston floods so quickly that if you guess wrong, if the rain comes in a little heavier and sooner than you anticipated, it could be too late. People could get stuck on the other side of rained out streets. It’s a risk you can’t take. Almost all the hospitals started calling in their relief teams Friday afternoon and evening. It got worse and worse on Saturday, and the storm just didn’t move. In the end we had enough staff, just barely.

What does ‘just barely’ mean, in this context?

We had a work shift, and a sleep shift. Our staff would work long shifts, sleep, then get right up and get back to work for a long shift. And remember that this was at the end of a week in which many of them had already worked long hours. Fatigue was perhaps the greatest challenge we faced. A stronger hurricane is more frightening, but this one just went on and on and on, and people were working constantly. You’d get just enough sleep to get back to work. It was exhausting, but it was also really rewarding to watch how people persevered through it. You’d see the staff go through the process of getting really, really tired and stressed, morale would begin to drop, then you’d push past it, and a real esprit de corps would emerge. We would begin to coalesce and come together.

How well was the hospital prepared for the hurricane, in terms of food, medicine, electricity, things like that?

There are minimum quantities of certain things we are required to keep on hand at all times, so for things like water, food, and medicine, we are always prepared. We always have a generator in case the main power goes out. The good thing about a hurricane is that typically you know it’s coming, so we brought in extra food and medicine. We augmented our stocks, and it was a good thing we did because of the duration of it. Towards the end we started running out of certain things like paper cups, milk, a few other things, but nothing serious. We had plenty of food and medicine, and we never lost power.

So what were the main challenges of operating during the hurricane?

I mentioned fatigue. That was a big challenge. We did eventually get some additional staff in, one or two at a time, but it was often impossible for people to reach us. They would call the command center and were so desperate to get to us to help, and sometimes we could help direct them around the flooded areas, but it wasn’t always possible. I had one physician who walked an hour through flooded streets to get here. He looked like a drowned rat when he got here, but it was so important to him to help. It was really heartening.

One of the challenges was figuring out where everyone would sleep and shower. We have those facilities set up for the patients, of course, but we are not accustomed to having to provide that kind of housing for so many of our staff. Finding enough showers is a difficult thing. We had people sleeping all over the hospital. Every spare waiting room, every spare space. Also, people are sleeping at all different times during the day, so we had to assign people as sleep monitors to make sure that those areas where people were sleeping were relatively quiet and dark, and that people didn’t walk in on them.

We had plenty of linens, but because our typical laundry service wasn’t available, it got dirty and needed to be cleaned. I had the C-suite executives folding clean linens and delivering them to the units. You saw people pitching in and doing what was necessary to get through.

How were the patients? Were they impacted by the crisis atmosphere?

The acuity of our patients was surprisingly low. They were aware of what was going on, and they realized that this was an unusual situation, and it seemed to have the effect of increasing the level of calm. I think nobody wanted to make life any more difficult living in the hospital than they had to. I think they knew the staff was stressed and stretched.

One of our bigger fears, because we are a standalone psychiatric hospital, is that we would have a serious medical need. We don’t have a lot of medical capabilities, and under normal circumstances we send people out if there are more serious medical needs. Fortunately, no one did. No pregnant patients who went into labor.

How were the staff affected by what was going on outside the hospital? There must have been people whose homes were flooded, or whose families had to evacuate.

About 10 percent of the staff were directly affected. Our medical director’s home flooded. Our executive director’s home was flooded. My daughter and grandson were in an area under a mandatory evacuation order. They went to my house, where my wife was, and then our neighborhood was evacuated. So then they went to a friend’s house, and then that house got evacuated. They had just gotten out of that house, and my wife was trying to drive around the floodwater, and her tire got punctured. Fortunately, she was able to transfer to my daughter’s car, but they barely got out. Early in the storm I got a call from Dr. Jair Soares, our executive director, and he told me that he and his family were going to stick it out, that he didn’t think they were going to get flooded. But they did, and they got trapped on the second floor. He and his wife and child were rescued by a boat the next day. These were not unusual stories. So many people were dealing with situations like these. It was a really scary time, and a lot of people felt really torn. I’ve gotta help patients here, but I have to find a way to take care of my family. We had two employees who lost a friend or family member in the floods.

The really remarkable thing, though, was that people kept trying to get in here to help. One of the main memories I have from this is of the people who kept trying and trying to get in here to see patients. The statement I heard more than anything was: What can I do? What can do I to help? The longer it went on the more I heard that. We talked a lot about how an event like this either tears you apart or brings you together, and it brought us together.

What now? Are you seeing an impact on people’s mental health in the aftermath of the hurricane?

We are part of a regional group of behavioral health providers that has been meeting and talking about the aftereffects since immediately after the storm [was] over. What we have seen so far is that the inpatient providers aren’t seeing so much of an increase in problems, but the outpatient providers have seen a big influx of people suffering trauma.

Why the difference?

As a general statement, you have to be really sick to warrant inpatient admission, so we are talking about serious episodes of psychosis, schizophrenia, things like that. These illnesses can be triggered or exacerbated by environmental stress, but it’s not usually so linear. Whereas the less serious trauma, that is dealt with through counseling and other outpatient services, can manifest quickly and directly as a result of dealing with something like this.

One thing we are concerned about, which we’ve talked a lot about, is that there is likely to be a delayed impact of the trauma that people lived through. That in the short term people are dealing with the really immediate challenges of getting back into their homes, finding places to live, cleaning. But after that settles down, often that’s when the trauma begins to manifest in their lives and affect them. We are gearing up to deal with the delayed trauma responses. We have learned from Hurricane Katrina and others that this does actually happen.

What does it mean to prepare for that? To gear up?

It will affect all the levels of care to some degree. One example is that we are doing a lot of work in schools already, because we are concerned about the effect it will have on kids. We are training counselors and administrators and teachers to be alert to problems that turn up, and to know what to do.

We have interviewed a number of different groups that specialize in community-wide trauma, learning from them what kinds of initiatives and programs can help, what kind of monitoring we’ll need to do.

Final thoughts?

It was extraordinary to see what people are capable of in such situations. It’s inspiring. I think about after the storm ended, and how so many people whose homes didn’t flood turned almost immediately to helping out with friends and family whose homes did flood. Our staff left the hospital, in many cases, and the next day were in a friend’s home helping them muck out. That was nasty work. The smell was awful. We spent the whole next weekend doing hard labor helping friends. I drove into a neighborhood near us that did flood badly, and there were hundreds of cars parked on both sides of the streets. We realized they weren’t the cars of the residents. It was people who had driven in from other areas to help. Friends, family, strangers who wanted to help. At lunchtime, I saw these pop-up tents going up all over the neighborhood, and it was people who had brought their grills and food and were providing lunch for everyone. None of this was organized. They just spontaneously came in to feed the volunteers. There was literally a traffic jam from so many people coming to help. The police had to come in to navigate.